1. Module 1: Course Overview

2. Course Objectives Teach you everything you need to know about the TB Program Describe TB the roles and responsibilities of the District TB Coordinator (TBCO)

3. Session Objectives Describe purpose of training course Outline the two main principles of TB/HIV collaborative activities Explain how the BNTP works

4. The BIG Picture

5. Leading Causes of Mortality from Infectious Diseases, 2001 Respiratory infections3.9* AIDS2.9 Diarrheal diseases1.9 Tuberculosis1.6 Malaria1.1 *in millions Source: WHO/CDS/2003.15

6. Tuberculosis: A Global Emergency 1/3 of the world’s population is infected TB kills one person every 17 seconds! –2 million each year –98% in developing world 9 million new cases –80% in 22 high-burden countries MDR and XDR TB threaten TB control TB/HIV coinfection: a growing syndemic

7. Background--Botswana High rates of TB and HIV 60-84% of TB patients are HIV-infected HIV is strongest known risk factor for developing active TB disease TB is most common cause of death for persons with HIV

8. Gain a better understanding of the TB/HIV burden in patients and communities through data collection Ensure that TB/HIV patients have access to care and treatment for both diseases To effectively fight these two diseases, TB and HIV Programmes must work together to: One Patient, Two Diseases

9. Principles of TB/HIV Collaboration “Two diseases, one patient” –Patient-focused care delivery for both diseases at the same time No separate programme –Collaborative activities add to existing TB and HIV/AIDS control strategies Policy needs to be global

10. Principles of TB/HIV Collaboration TB is part of the problem, but TB is also part of the solution –Use of TB infrastructure –Direct observation of treatment (DOT) and DOTS strategy –Experience in procuring low cost, high quality drugs (Global Drug Facility and Green Light Committee)

11. Goals of TB/HIV Collaborative Activities Reduce the burden of TB among people living with HIV/AIDS –Intensified case-finding –Treatment of latent TB infection through IPT –TB infection control in health care and congregate settings Reduce the burden of HIV in TB patients –Routine HIV testing –HIV prevention –HIV care and treatment including ART –Provision of cotrimoxazole preventive therapy WHO/HTM/TB/2004.342

12. Fighting TB and HIV Nelson Mandela at 2004 International AIDS Conference (http://news.bbc.co.uk/1/hi/world/asia-Pacific/3895525.stm) “We cannot win the battle against AIDS if we do not also fight TB. TB is too often a death sentence for people with AIDS ”. Nelson Mandela

13. Role of National TB Program Develops national policies and guidelines Manages drug supply Coordinates data collection and prepares national surveillance reports Provides –oversight of district programs –leadership and training to districts –technical assistance Responsible for reporting to PS and to WHO

14. Role of District TB Coordinators Provide technical support to facility-level HCWs on TB IPT Follow-up on laboratory specimens submitted for culture & DST Other training/technical assistance as needed Provide Supervision of the CTBC program Collects facility-level TB and IPT data –Responsible for ALL district-level data entry, cleaning and reporting Prepare monthly surveillance reports for BNTP Prepare monthly QA reports for each facility Provide data to Regional IPT Coordinator who reports to BNTP

15. Current Technical Context Minimum essential set of technical guidelines: Strategic framework Guidelines for TB and HIV collaborative activities

16. ProTEST: “Virtuous Circle” which Links RHT to HIV and TB Care RHT for HIV Range of interventions for HIV/TB prevention and care Entry point for access to HIV/TB prevention and care Uptake of RHT HIV TB and other HIV related diseases

17. MOH Organizational Chart Div AIDS Care Prev

18. MOH MOLG National Health Laboratories National TB Reference Laboratory Disease Control Division BNTP District Hospitals and Laboratory Services Primary Hospitals and Laboratory Services Referral Hospitals and Laboratory Services Private Laboratories (QA partially through NTRL) Primary Clinics Clinical ServicesPublic Health IPT Primary clinics fall under primary hospitals Direct Supervision Quality Assurance Supervisory and Quality Assurance Relationships